India being termed the world capital of diabetes, work is cut out for rural care organizations. In the light of changing lifestyle of the rural population, it becomes necessary to develop a model for diabetes control for the people. The FRCH launched a Comprehensive Diabetes Control Programme in 2007, based on the feedback received through the focus group discussions with the local community in the Parinche valley. The programme aims at creating a replicable model of diabetes management in rural areas and covers about 10,000 population in 10 villages in the Purandar block of Western Maharashtra.

As the first step, the community health workers were trained extensively in various diagnostic and management aspects of diabetes by specialists in respective fields. The training covered basics of diabetes, anthropometric measurements, nutritional counseling and emergency management. The health workers learned to identify high-risk groups as well as use of the Hemoque Analyzer for measurement of blood sugar levels (BSL). Armed with this knowledge, they organized awareness programmes in the study area, using street plays, songs, posters and also held discussions with the community, emphasizing the need for timely diagnosis of diabetes.

The awareness campaign was followed by community survey for risk factors, supplemented by blood sugar level testing. A clinic was scheduled once a month at Parinche, where diagnosis was confirmed and treatment given. The activity is now expanded to three more clinics in order to achieve visibility and extend population coverage. A diabetologist and a physician are available for consultation at the clinics. Patients are screened for complications and advised in referrals. A team of ten to fifteen community health workers share responsibility for awareness generation, screening, BSL testing, regular follow-up of patients, counseling and distribution of medicines as per the doctor's orders. Medicines are available at half the market price and the diagnostic tests cost one-tenth of commercial costs.

Each clinic is visited on an average by 30-35 patients.Related problems such as hypertension are also treated at the clinic.
An identity card is designed for each patient, wherein his diagnosis and follow-up history are recorded.

Referral system for complications
With more and more community members coming forward voluntarily for screening and treatment, replication of the programme in other villages around the valley seems a logical future. Three health camps have been organized so far to cover diabetes-related issues. The possibility of setting up a referral system for complications is now being explored. Training of local health care personnel, addressing gestational diabetes and family involvement in diabetes treatment are some other activities that are being planned.